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PERMIT APPLICATION <br /> BUILDING/MECHANICALIPLUMBINGISIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810-FkX 425-257-8857-www.everettwa.o�7 `I Z <br /> (e✓e$F T-r N��„�N APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � <br /> SITEADDRESS: �4�Tth PRGPERiYTAXM PERM p _ <br /> Z�U'�. u,�B e �,1. �J 9 o ODN3� I�ZS vp I00 <br /> LECaAL br new construction: Short PlaVsubdrvlsion,�l 77 Lol No._ (aqach coDY ol long Iegal desenption) <br /> r�IA.,� r 'iZ5 '�9 �N558 <br /> OWNER �� pr1?��- ��IYie�7 Li fJ PhonelE-mail _ D �" •un� <br /> Address (pD1 10�� v�. �E CitylState2ip �U� � �l <br /> CONTRACTOR L&I Lic.# <br /> Address PhonelEmail <br /> TENANTBUSINESSNAME CONTACTFOR3�MI�T �NY Zab-b23••N�oy� <br /> y�Y��NK Phonc/E-mail , [-QV�y� � bA.��15D5�• <br /> BUILDING PERMIT APPLICATION CONrr�ncrPRiCEOFwoRK �9��000 <br /> Existing Use of Building RA�JY. . HEAT SOURCE: <br /> Proposed Use of Building BR�K- Gas_ Eiectdc Oiher <br /> Building lype: _Single Family _Duplez_Townhouse _Multi-Family �Commercial <br /> Type oi project: _New _Addition _Remodel _Repair�T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DescriptionofWork(addftionaispacaprovidedonfhe6ack�: � ��L(��e!) <br /> TL-n1ANT IMP�G✓EM�E��T oF RN �K�STIti1(r 'DP-A"NL-�I ��N� ' �K" <br /> Nor1-ST12uGTtA��tL PA,RTiTIoNS � FirJiSHESiFU,12nJ1'�e�, ft1-�b R-L'v�'�D �I�ELl1�ILkL <br /> Hav�u slarted working willenut a pe�mil7 _YES �NO <br /> MECHANICAL PERMIT APPLICATION ,�� PLUMBING PERMIT APPLICATION �J/f} <br /> TypeolProJect: _New_Addn _Alterotion_Repair TypeofProject: _New_Addn _Alteration_Repair <br /> Show Number(#)ol IJxNres Show Number(q)o!/irfures <br /> A/C—airhandlin units I Toilet <br /> Fcrced air s stems Bathtub <br /> I� Gas piping � Lavato (wash basin <br /> i Water heater I Shower <br /> � Gas fireplace Kitchen sink 8 disposal <br /> I Gas ranqe Dishwasher <br /> I Clolhes d er I Clothes washer <br /> Ran e hood I Water heater <br /> Exhaust fan I Sink servicelbar/mopletc.) <br /> � Heat pump I Backflow �revenier <br /> I Uni�heater Urinal i <br /> � Boiler Drinkin Fountain , <br /> � Relri eration � Floor drain <br /> I Wondstovr. I Greaselrap <br /> � Uucting � Roof drains <br /> i Other � Medical Gas <br /> SPRINKLER! SUPPRESSION SYSTEM other. <br /> � Number of lieads I Other: <br /> I hereby certily thal I havo mad and examined this appticalion and know tho samo lo be true and covect.NI provicions o(laws and ordinances govemiiq <br /> rt�is typo of work wl��be complied vnth wfiether specil�ed herein or nul.The granting ot a pertnit dces not presume lo give autnedry to vwlale or cancel <br /> n�c provision of eny other stala or local law regulating construction or the peAortnanca oi consfrudion.That I am aulfwdzed by the ovmer ol�his property � <br /> to pedorm Ihe work fm which appliwlion is made and I tomply wllh 1M�Slete Conl2elors Lew 1827 RCW and 296.200\YAC l <br /> � v <br /> �y ��.�.�- =.,25�I1 <br /> OwnM Nhodzed Agenl S� na re Oate (Revised7/2011) <br /> ju� �L-n)�Y <br />